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Is it Wise to be Conventional?

In hospitals, conventional wisdom generally is to not "rock the boat" when dealing with physicians, who, it is believed, do not take well to change. In many cases, the result has been painfully slow implementation of information systems. Whether as relatively simple as adapting to digital dictation and electronic signature authentication, a bit more complicated as retrieving lab results online, or as complex as computerized provider order entry (CPOE), the strategy deployed by hospitals is generally to ease into such systems. Certainly CPOE should be the last component of a hospital's EHR strategy to be implemented; nurses should adopt documentation and barcode medicationadministrationrecord (BC-MAR) systems before physicians start using CPOE.

But is conventional wisdom always wise? For many hospitals, implementing CPOE last may be the best strategy. However, you need to examine options, reasons and motivations � including understanding if your physicians will resist starting with CPOE earlier. In general, physicians are conservative. This does not necessarily mean they won't change, but they are data-driven. They want assurance that changes they are asked to make will have no adverse impact on their practice, and ideally will improve it. Merely citing potential benefits will not convince them. They need to be given the facts — and be engaged in the process — to ensure that the system has no more imperfections than the current environment.

It may require special effort to convince physicians that CPOE will cause no direct or indirect harm to the patient. CPOE may be touted as a patient safety technology, but until physicians work through all aspects of the potential implications of CPOE for themselves, they will not be convinced. Another critical concern is whether physicians perceive the CPOE process to take more time than the existing process. It may be difficult to guarantee that no additional physician time will be required; they'll need to look at downstream changes, such as fewer calls from nurses and pharmacists, to assess the overall time impact. Accordingly, hospitals should work with physicians to:


  • train them and give them greater confidence that they have the necessary computer skills;


  • gain their involvement in setting up order sets and reviewing clinical decision support; and


  • support physician learning of the new process.


    Demonstrating results

    Asking physicians to work on a specific task where they can see immediate results from their efforts is a key to EHR success. Physicians really only have two key assets — their knowledge and their time. In whatever you ask them to do, be sure to consider both of those assets. Asking them to review clinical protocols, for example, can enhance their knowledge base. Incorporating the change immediately into a paper order set or template for dictation that will ultimately be embedded in the EHR impresses upon them that their time was not wasted.

    Finally, when a hospital is debating the merits of BC-MAR vs. CPOE or any other information systems sequencing dilemma, important dependencies must be considered. BC-MAR may have a huge impact on other systems and require costly hardware and networking changes. CPOE may be less expensive and more logical to implement first. Why buck such conventional wisdom by installing the most complex system first?


    Margret Amatayakul ("Margret A") is president of MargretA Consulting, LLC, an EHR consulting firm. Contact her at or

    Mike Cohen is president of MRC Consulting Group, a St. Charles, Ill., firm dedicated to helping health care organizations make good decisions and get more value from their information systems investments. He is also a principal in Cardinal Consulting, Inc. You can e-mail him at or visit his Web site at


    Source:  Vol. 11 •Issue 9 • Page 14 , Is it Wise to be Conventional? , Asking physicians to work on a specific task where they can see immediate results from their efforts is a key to EHR success.,
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